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Original article
Conservative treatment of anterior chronic exertional compartment syndrome in the military, with a mid-term follow-up
  1. Wes O Zimmermann1,2,
  2. Mark Robert Hutchinson3,
  3. Ruud Van den Berg4,
  4. Rigo Hoencamp5,6,
  5. Frank J G Backx7,
  6. Eric W P Bakker8
  1. 1 Department of Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, Netherlands
  2. 2 Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
  3. 3 Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, USA
  4. 4 Medical School, Free University of Amsterdam, Amsterdam, Netherlands
  5. 5 General Surgery, Alrijne Ziekenhuis, Leiden, Netherlands
  6. 6 The Office of the Surgeon General for all Armed Forces, Ministry of Defense, Utrecht, Netherlands
  7. 7 Sports Medicine, University Hospital, Utrecht, Netherlands
  8. 8 Division of Clinical Methods and Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
  1. Correspondence to Dr Wes O Zimmermann; wesselzimmermann{at}hotmail.com

Abstract

Objectives To assess the outcome of conservative treatment for chronic exertional compartment syndrome (CECS) as it relates to the reduction in surgical fasciotomy and return to active duty in a military population.

Methods Historic cohort. From 2015 to 2018, 75 surgically eligible patients with pressure-positive anterior CECS (Group 1), or with positive pressures and associated medial tibial stress syndrome (Group 2), underwent a conservative treatment programme emphasising gait retraining of running and marching. Treatment success was defined as return to duty, without surgery. Fifty patients from 2015 to 2017 were surveyed to assess mid-term outcomes.

Results The average duration of conservative treatment was 144.9 (±59.6) days. Initially, 65% (49/75) were able to return to duty; 28% (21/75) were referred for surgery and 7% (5/75) left the armed forces. There was no difference in outcomes between Group 1 and Group 2. Survey response rate, on average after 742 days (SD 267, range 381–1256), was 84% (42/50); 57% (24/42) had continued duty, without surgery; of them, 43% were at the same military specialty, 57% in a physically less demanding job.

Conclusion A conservative treatment programme for anterior CECS was able to return 65 % of patients to active duty, without surgery. At 2 years, the success rate decreased slightly, but remained positive at 57%. In this high-risk group, initiating a conservative treatment protocol with an emphasis on gait retraining can significantly reduce the need for surgical fasciotomy. For those that fail conservative treatment, surgical release may still be indicated.

  • exercise related leg pain
  • gait retraining
  • fasciotomy
  • occupational
  • prognosis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjsem-2019-000532

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    Footnotes

    • Contributors WOZ: research initiative, principal author and guarantor. MRH: significant reviewer/reviser. RVdB: follow-up survey execution and analysis. RH: reviewer/reviser. FJGB: reviewer/reviser. EWPB scientific advisor, significant reviewer/reviser.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement statement At the conclusion of treatment programmes, patients are always asked to provide recommendations for improvement of care. From this information new research questions are formulated. As part of the informed consent procedure patients are offered the final report of the study they participated in.

    • Patient consent for publication Not required.

    • Ethics approval Dutch law does not require approval of an ethical board for this type of study.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement Data are available on reasonable request. All relevant, anonymous data are available in a single Microsoft Excel file. The guarantor of this article will provide the data (wo.zimmermann@mindef.nl).